POS0309 TIME TRENDS IN GLUCOCORTICOID USE IN RHEUMATOID ARTHRITIS DURING THE BIOLOGICS ERA: 1999-2018
Authors: L. Crowson, J. M. Davis, A. Hanson, E. Myasoedova, V. Kronzer, A. Makol, L. Peterson, D. Bekele, C. S. Crowson
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Clinical guidelines recommend minimizing glucocorticoid use among patients with rheumatoid arthritis (RA) and many new therapeutic options in recent decades offer alternatives to glucocorticoids, but it is unknown whether glucocorticoid use has declined in patients with RA. <h3>Objectives</h3> To examine time trends in glucocorticoid use among patients diagnosed with rheumatoid arthritis (RA) during the biologic era. <h3>Methods</h3> A population-based inception cohort of RA patients diagnosed during 1999 - 2018 was followed longitudinally through their medical records until death, migration or 12/31/2020. All patients fulfilled 1987 and/or 2010 American College of Rheumatology classification criteria for RA. Glucocorticoid start and stop dates were collected along with dosages in prednisone equivalents. The cumulative incidence of glucocorticoid initiation and discontinuation adjusted for the competing risk of death was estimated. Cox models adjusted for age and sex were used to compare trends between time periods. <h3>Results</h3> The study population was comprised of 399 patients (71% females) diagnosed in 1999 – 2008 and 430 patients (67% females) diagnosed in 2009 – 2018. Glucocorticoid use was initiated within 6 months of meeting RA criteria in 66.7% of patients in 1999-2008 and 70.9% of patients in 2009-2018, corresponding to a 29% increase in hazard for initiation of glucocorticoids in 2009-2018 (adjusted hazard ratio [HR]: 1.29; 95% confidence interval[CI]: 1.09-1.53). Among glucocorticoid users, similar rates of glucocorticoid discontinuation within 6 months after glucocorticoid initiation were observed in patients with RA incidence in 1999 – 2008 and 2009 – 2018 (39.1% versus 42.9%, respectively), with no significant association in adjusted Cox models (HR: 1.11; 95% CI: 0.93-1.31). Even in the 2009-2018 cohort, a large proportion of patients with RA (52%) remained on glucocorticoids beyond 3 months, and 30% were still on glucocorticoids after 2 years. Older patients with RA were more likely to initiate glucocorticoids (HR 1.06 per 10 year increase in age, 95% CI 1.00-1.13) and less likely to discontinue glucocorticoids (HR 0.91 per 10 year increase in age, 95% CI 0.86-0.96). There was no difference in the initiation of glucocorticoids by sex. Although females had a higher discontinuation rate within the first 12 months, afterwards discontinuation rates of glucocorticoids were similar in females and males. Smokers were less likely to discontinue glucocorticoids compared to non-smokers (HR 0.65; 95% CI: 0.51-0.82). <h3>Conclusion</h3> More patients are initiating glucocorticoids early in their disease course now compared to previously despite the availability of biologics and other disease modifying antirheumatic drugs. The rates of glucocorticoid discontinuation are similar. A substantial proportion of patients remain on glucocorticoids for more than 3 months with a large proportion continuing use of glucocorticoidss even beyond 2 years. Real world use of glucocorticoids in patients with RA is not optimal or improving despite advances in RA therapy. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> Lisa Crowson: None declared, John M Davis III Grant/research support from: Pfizer, Andrew Hanson: None declared, Elena Myasoedova: None declared, Vanessa Kronzer: None declared, Ashima Makol Consultant of: Boehringer Ingelheim, Lynne Peterson: None declared, Delamo Bekele: None declared, Cynthia S. Crowson: None declared.